Abstract
It is unclear whether Early Extubation (EE) practices affect the patient outcomes after Acute High-risk Abdominal (AHA) surgery. This study aims to explore the impact of EE on the postoperative prognosis of AHA surgery patients. A screening and analysis were performed among 9219 patients who underwent AHA surgery from January 2012 to December 2019. After meeting the pre-determined extubation criteria, patients were divided into two groups: EE (≤ 4 h) and Delayed Extubation (DE) (< 4 h) according to the time of extubation. Various clinical indicators were compared between the EE and DE groups after propensity-score matching. Hospital stay was the primary outcome assessed. And multivariate and subgroup analyses were performed to identify independent predictors of hospital stay length. After propensity-score matching, a total of 1074 patients were enrolled, including 537 in the EE group and 537 in the DE group. A greater number of DE patients underwent laparotomy and used vasoactive drugs than EE patients (p < 0.001). Compared to the DE group, the EE group had significantly shorter intubation time (285 [IQR 225, 350] vs. 427[IQR 300, 514]), lower postoperative pulmonary infection rates, and considerably shorter hospital stay (12 [IQR 10, 16] vs. 14 [IQR 10, 19]) (p < 0.001). In stepwise multivariable analysis, EE status (BETA-2.075; 95%CI (-2.898, -1.217)) and postoperative pulmonary infection (BETA 0.401; 95%CI (-2.898, -1.217)) were identified as independent variables associated with a longer hospital stay. Furthermore, EE status were identified as independent variables associated with a longer hospital stay, in subgroups (various diagnosis, BMI and sex) analysis. Extubation within 4 h of meeting extubation criteria in AHA surgery was associated with improved postoperative outcomes, including reduced postoperative pulmonary infection, and a shorter hospital stay. However, prospective randomized controlled trials are needed to confirm the observed benefits and establish optimal timing for extubation.
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-025-17380-9.
Subject terms: Circulation, Respiration
Introduction
The acute high-risk abdominal (AHA) surgery refers to the emergency situations which requires immediate laparoscopic or open abdominal surgery. These are typically due to organ rupture, bowel perforation, intestinal obstruction, or ischemia, all of which result in high morbidity, mortality, and associated socioeconomic costs1–3. AHA under general anesthesia can result in postoperative complications like pneumonia and atelectasis4. People with obesity, cardiovascular, or chronic obstructive pulmonary disease (COPD) are particularly at risk5. Due to these reasons, patients are often required to admit into the intensive care unit (ICU) for prolonged mechanical ventilation after surgery. Aside from consuming a substantial amount of medical costs, mechanical ventilation can also cause related complications, such as cardiopulmonary issues6. Official recommendations on the optimal time and criteria’s for extubation following AHA surgery have not yet been outlined. Additionally, not enough attention has currently been devoted to improving perioperative surgical and anesthetic management for AHA surgery.
Early extubation (EE) has been widely recognized as an essential strategy for optimizing anesthetic management after surgery7. Numerous studies have investigated its impact on patient outcomes following various kinds of procedures. one such investigation demonstrated that liver transplant patients who underwent EE after surgery experienced shorter ICU stays and significantly fewer total hospitalization days compared with those whose extubations was delayed by two or more days8. In addition, an EE protocol has been initiated by surgeons, anesthesiologists, and ICU personnel for coronary artery bypass grafting (CABG) and valve replacement surgeries9,10, while enhanced recovery after Surgery (ERAS) guidelines incorporate EE as part of gastrointestinal surgeries11.
However, no guidelines exist yet regarding EE for AHA surgery patients. Some physicians posit that EE may lead to an elevated risk of reintubation due to postoperative respiratory distress, as well as an increased incidence of cardiovascular complications and aspiration pneumonia12. Anesthesiologists utilize a variety of factors, such as patient conditions, surgical predictions, intensive care bed availability, and family preferences, to inform their decision-making process for AHA surgery patients. Thus, the extubation time varies widely among hospitals or anesthesiologists after AHA surgery. Currently, there is a lack of research examining the impact of early enteral nutrition (EE) on the prognosis of patients undergoing acute hemorrhagic appendicitis (AHA) surgery. This study aims to assess the influence of EE on the postoperative results of AHA surgery patients, with the goal of offering clinicians more accurate guidance and treatment suggestions to enhance postoperative outcomes, minimize complications, and improve therapeutic efficacy.
Methods
Study design
This was a single-center retrospective cohort study conducted at the Third Xiangya Hospital, Central South University in China. A screening was conducted to identify eligible patients admitted between January 1, 2012, and December 30, 2019. Data were obtained from the hospital’s anesthesia system and the hospital data center’s application sharing platform. This study was approved by the Ethics Committee of Xiangya Third Hospital (approval number:23361). All study procedures were strictly performed in accordance with relevant guidelines and regulations. The Ethics Committee of Xiangya Third Hospital waived the requirement for informed consent due to the retrospective nature of this study.
Inclusion and exclusion criteria
Patients ranging in age from 18 to 85 years were enrolled. They underwent emergency laparotomies or laparoscopies due to organ ruptures, bowel perforations, intestinal obstructions, or intestinal ischemia. Their conditions include (A) invasive mechanical ventilation under general anesthesia with endotracheal intubation; (B) they were “extubatable” after the surgery; (C) there were no known consciousness disorders before meeting extubation criteria; (D) no aspiration occurred during or before anesthesia induction.
The exclusion criteria were as follows: Intraoperative death; severe preexisting comorbidity such as severe cardiopulmonary dysfunction before surgery; multiple traumas, including craniocerebral injury, cerebrovascular accidents, and chest injuries; Failure to achieve “extubatable” status postoperatively; incomplete medical records. A state described as “extubatable” at the end of surgery is defined as meeting the following criteria: (1) The airways peak pressure during controlled ventilation is less than 30 cmH2O, with a positive end-expiratory pressure below 5 cmH2O; (2) The arterial oxygen pressure (PaO2) versus the fraction of inspired oxygen (FiO2); PaO2/FiO2 (> 200); (3) No preoperative consciousness disorder or comorbid brain injury; (4) Hemodynamic stability: Norepinephrine infusion rate of less than 0.1ug/kg/min; (5) A body temperature below 38 °C; (6) A lactate level of less than 2 mmol/L.
Related variables
All patients were evaluated for demographic data, comorbidities, surgical details, and outcomes through the surgical anesthesia system and the HIS medical workstation medical record system. We defined early extubation as the extubation within 4 h of meeting extubation criteria after the end of surgery13. Extubation criteria was judged by two ICU doctors according to the medical procedure. Intubation time as the duration from the insertion of the endotracheal tube preoperatively to the first extubation in ICU or operation room. Reintubation refers to endotracheal intubation again within 24 h of extubation. Patients with lung infections appear in the discharge diagnosis or in medical records as cases of pulmonary infection. As the vasoconstrictor drugs used intraoperatively in this center were all norepinephrine, we defined the use of vasoactive drugs as patients with an intraoperative norepinephrine infusion rate exceeding 0.1ug/kg/min. Patient mortality was defined as those who died during the hospital stay. The primary outcome of interest in this study was the length of hospital stay. All surgical teams adhered to institutional protocols for emergency laparotomies. Staffing rotations were not analyzed due to consistent clinical thresholds across personnel.
Statistical analysis
After preliminary data organization using Excel 2010, SPSS 26.0 was used for statistical analysis. Chi-square test was employed for categorical data, while normality test was conducted for continuous data. Normally distributed continuous variables were expressed as “mean ± standard deviation,” and non-normally distributed variables were presented as median and interquartile range (IQR) M (P25-P75). Independent samples t-test was used for comparing two groups with normally distributed data, while Mann-Whitney U test was used for comparing two groups with non-normally distributed data. Given the differences in the baseline characteristics between the two groups, propensity-score matching (PSM) was used to identify a cohort of patients with similar baseline. Matching was performed with the use of a 1:1 matching protocol without replacement (greedy-matching algorithm), with a caliper width equal to 0.2 of the standard deviation of the logic of the propensity score. Linear regression analysis was performed to identify independent influencing factors, variance inflation factor (VIF) coefficients were calculated and a significance level of p < 0.05 was considered statistically significant.
Results
Out of 9219 cases of acute abdominal surgeries, we enrolled 1354 patients who underwent AHA surgery between January 2012 and December 2019 before PSM (Fig. 1). We excluded patients undergoing non-AHA surgeries, those with injuries to other important organs, those not meeting the criteria for extubation, as well as children and pregnant women.
Fig. 1.
A comprehensive standard study flow diagram.
Through the Pearson χ2 trend test, we found significant association between EE and the year of surgery from 2012 to 2019 (p < 0.05). Figure s1 showed the number of surgeries with early and delayed extubation during this eight-year period.
In our study cohort before PSM, most patients were male (64.99%). Among them, 671 patients (EE group) were successfully extubated within 4 h, while 683 patients (DE group) were extubated after 4 h of ICU admission (Table 1). Besides, there were significant differences between the EE group and the DE group in terms of Body Mass Index (BMI) (p = 0.029) and ASA classification (p = 0.043). However, after PSM, the final study cohort enrolled 1074 patients and there were no significant differences between the early extubation group (EE group) and the delayed extubation group (DE group) in terms of gender, age, and diagnosis (all p > 0.05). Furthermore, there were no significant differences between the two groups in terms of comorbidities (such as COPD, hypertension, diabetes, etc.).
Table 1.
Demography and general characteristics of patients before and after propensity score matching.
| Characters | before PSM | after PSM | ||||
|---|---|---|---|---|---|---|
| EE (n = 671) | DE (n = 683) | p | EE (n = 537) | DE (n = 537) | p | |
| Demographics | ||||||
| Age, years | 57(45, 69) | 57(45, 68) | > 0.05 | 58(45,68) | 58 (45,68) | > 0.05 |
| Male, n (%) | 433(238) | 447(236) | > 0.05 | 346 (64.43) | 340 (63.31) | > 0.05 |
| BMI (kg/m2) | 25.28 (22.44, 27.77) | 24.48 (22.41, 27.11) | 0.029* | 25.07 (22.43, 27.73) | 24.74 (22.49, 27.25) | > 0.05 |
| ASA(II/III/IV) | 7/255/409 | 6/216/461 | 0.043* | 0/198/339 | 0/182/355 | > 0.05 |
| Diagnosis, n | ||||||
| GPOB | 436 | 451 | > 0.05 | 347 | 342 | > 0.05 |
| GO | 215 | 214 | 174 | 178 | ||
| Intestinal ischemia | 20 | 18 | 16 | 17 | ||
| Comorbidities | ||||||
| Hypertension, n (%) | 179 (26.68) | 171 (25.07) | > 0.05 | 143 (26.63) | 143 (26.68) | > 0.05 |
| COPD, n (%) | 34 (5.07) | 32 (4.69) | > 0.05 | 28 (5.21) | 25 (4.66) | > 0.05 |
| Diabetes, n (%) | 96 (14.31) | 93 (13.62) | > 0.05 | 79 (14.71) | 75 (13.97) | > 0.05 |
| CAD, n (%) | 72 (10.75) | 72 (10.54) | > 0.05 | 59 (10.99) | 61 (11.36) | > 0.05 |
| RI, n (%) | 22 (3.28) | 25 (3.67) | > 0.05 | 17 (3.17) | 22 (4.10) | > 0.05 |
PSM, propensity-score matching; BMI, Body Mass Index; ASA, American Society of Anesthesiologists grades; GPOB, Gastrointestinal perforation, organ rupture and bleeding; GO, Gastrointestinal obstruction; CAD, Coronary artery disease; RI, Renal insufficiency.
Comparison of intraoperative parameters between patients with EE and DE groups. Data are presented as median (IQR) or frequency (%). P-values that are considered statistically significant (<0.05) are given in bold. DE: delayed extubation; EE: early extubation; IQR: interquartile range.
For general anesthesia, all surgeries were performed under total intravenous and inhalation combined anesthesia, with anesthetic agents including sevoflurane, propofol, opioids, and muscle relaxants. No significant differences existed between DE and EE groups regarding operation time, anesthesia time, blood loss, reintubation rate within 24 h postoperatively, and in-hospital mortality (p > 0.05). However, more patients in DE underwent laparotomy and used vasoactive drugs than in EE (p < 0.001). Also, in comparison with the EE group, intubation times for DE were longer (285 [IQR 225, 350] vs. 427[IQR 300, 514]). And a higher postoperative pulmonary infection rate and longer total hospital stay (12 [IQR 10, 16] vs. 14 [IQR 10, 19]) (p < 0.001) were found in EE. In each group, there were 2 patients required reintubation within 24 h postoperatively. Of these 4 patients, 2 in the DE group required reintubation due to postoperative bleeding, while in the EE group, 1 patient required emergent intubation due to rebleeding and 1 due to acute respiratory distress syndrome (ARDS) (Table 2). To clarify, none of the patients received reversal agents following surgery, including neostigmine, sugammadex and others. No cases of aspiration occurred in all patients who had early or late extubation. None of the patients used patient-controlled intravenous analgesia postoperatively. Due to the high infection risk in this cohort, epidural anesthesia was not utilized.
Table 2.
The comparison of intraoperative and postoperative outcomes between two groups before and after propensity score matching.
| Characters | Before PSM | After PSM | ||||
|---|---|---|---|---|---|---|
| EE (n = 671) | DE (n = 683) | p | EE (n = 537) | DE (n = 537) | p | |
| Intraoperative | ||||||
| Operative time, minutes | 140(100,195) | 138(96,189) | > 0.05 | 140(100,191) | 135(95,185) | > 0.05 |
| Anesthetic time, minutes | 250(190,310) | 242(185,305) | > 0.05 | 250(190,310) | 240(185,305) | > 0.05 |
| Type of surgery, n | < 0.001 | 0.013 | ||||
| Emergency laparotomy | 552 | 619 | 449 | 477 | ||
| Emergency laparoscopy | 119 | 64 | 88 | 60 | ||
| Blood loss, mL | 150(100, 300) | 150(100,300) | > 0.05 | 150 (100–300) | 150(100–300) | > 0.05 |
| Vasoconstrictor drugs used, n (%) | 211 (31.49) | 373 (54.61) | < 0.001 | 198 (36.87) | 239 (44.51) | 0.011* |
| Postoperative outcomes | ||||||
| TI duration, minutes | 287(225,348.5) | 433(300,516) | < 0.001 | 285 (225–350) | 427(300–514) | < 0.001 |
| Reintubation, n (%) | 2 (0.30) | 2 (0.29) | > 0.05 | 2 (0.37) | 2 (0.37) | > 0.05 |
| Pneumonia, n (%) | 34 (5.07) | 76 (11.13) | < 0.001 | 28 (5.21) | 64 (11.92) | < 0.001 |
| Hospital stays, days | 12(10, 16) | 14(10, 19) | < 0.001 | 12 (10–16) | 14 (10–19) | < 0.001 |
| In-hospital mortality, n (%) | 6 (0.89) | 4 (0.59) | > 0.05 | 4 (0.74) | 1 (0.19) | > 0.05 |
PSM, propensity-score matching; TI, Tracheal intubation.
Comparison of intraoperative parameters between patients with EE and DE groups. Data are presented as median (IQR) or frequency (%). P-values that are considered statistically significant (< 0.05) are given in bold. DE: delayed extubation; EE: early extubation; IQR: interquartile range.
Univariable analysis and multivariable regression analysis with backward selection for primary outcome length of hospital stay as a continuous variable. Univariable analyses identified duration of intubation, BMI, EE, and surgical type were identified as risk factors associated with prolonged hospital stay (Table 3). Operation time, anesthesia time, and complications were not associated with increased length of stay.
Table 3.
Univariable analysis for hospital stay.
| Beta | 95% CI | p | |
|---|---|---|---|
| Demographics | |||
| Age | −0.015 | −0.039, 0.008 | 0.205 |
| Sex | −0.257 | −1.132, 0.617 | 0.565 |
| BMI | −0.163 | −0.282, −0.045 | 0.007 |
| ASA | |||
| 3 | 0 | ||
| 4 | 0.591 | −0.287,1.470 | 0.187 |
| Diagnosis | |||
| GPOB | 0 | ||
| Gastrointestinal obstruction | −0.726 | −1.628, 0.175 | 0.114 |
| Intestinal ischemia | −0.163 | −2.615, 2.289 | 0.896 |
| Comorbidities | |||
| Chronic hypertension | −0.743 | −1.693,0.208 | 0.126 |
| COPD | −1.025 | −2.965,0.915 | 0.301 |
| Diabetes | −0.091 | −1.290,1.108 | 0.882 |
| Coronary artery disease | −0.426 | −1.759, 0.908 | 0.532 |
| Renal insufficiency | 1.409 | −0.836,3.655 | 0.219 |
| Intraoperative | |||
| Operative time | −0.001 | −0.004, 0.002 | 0.513 |
| Anesthetic time | 0.001 | −0.003, 0.004 | 0.749 |
| Type of surgery | −0.45 | −1.669,0.768 | 0.469 |
| Blood loss | 0.001 | −0.001,0.002 | 0.086 |
| Vasoconstrictor drugs used | 0.751 | −0.100,1.611 | 0.085 |
| Postoperative | |||
| Early extubation | −2.212 | −3.042, −1.382 | < 0.001 |
| TI duration | 0.001 | 0.001,0.002 | 0.183 |
| Reintubation | −1.007 | −7.905, 5.891 | 0.775 |
| Pneumonia | 2.315 | 0.819, 3.810 | 0.002 |
BMI, Body Mass Index; ASA, American Society of Anesthesiologists grades; GPOB, Gastrointestinal perforation, organ rupture and bleeding.
All parameters with univariable analyses displaying p values < 0.05 were entered in a multivariable model and other variables related to hospital stays reported from other research. In stepwise multivariable analysis, EE status (BETA-2.075; 95%CI (−2.898, −1.217)), and postoperative pulmonary infection (BETA 0.401; 95%CI (−2.898, −1.217)) were identified as two independent contributors to longer hospital stay after adjusted the possible variables related (Tables 4 and 5).
Table 4.
Multivariable analysis for hospital stays.
| model 1 | model 2 | model 3 | ||||
|---|---|---|---|---|---|---|
| Beta (95%CI) | p | Beta (95%CI) | p | Beta (95%CI) | p | |
| Early extubation | −2.212(−3.042, −1.382) | < 0.001 | −2.172(−3.012, −1.334) | < 0.001 | −2.075(−2.898, −1.217) | < 0.001 |
model1: no adjust.
model2: adjust adjust age; sex; bmi; ASA; vasoconstrictor drugs; type of surgery; blood loss; chronic hypertesion; diabetes; renal insufficiency; COPD;
model3: adjust for model 2 +diagnosis+pneumonia.
Table 5.
Multivariable analysis for pneumonia.
| model 1 | model 2 | model 3 | ||||
|---|---|---|---|---|---|---|
| Beta (95%CI) | p | Beta (95%CI) | p | Beta (95%CI) | p | |
| Early extubation | 0.407 (0.256, 0.645) | < 0.001 | 0.399 (0.248, 0.643) | < 0.001 | 0.401(0.249, 0.646) | < 0.001 |
model1: no adjust;.
model2: adjust adjust age; sex; bmi; ASA; vasoconstrictor drugs; type of surgery; blood loss; chronic hypertesion; diabetes; renal insufficiency; COPD;
model3: adjust for model 2 +diagnosis.
Additionally, in the multiple regressions, we used the VIF coefficients to diagnose multicollinearity and no variable showed VIF indicators of multicollinearity (all VIF < 10 in table s1). Furthermore, three subgroups (sex, obesity, various diagnosis) were tested the relationship between the EE status and hospital stays. In male and female subgroup, EE can less hospital stay (BETA − 2.093; 95%CI (−3.178, −1.008) and BETA − 2.193; 95%CI (−3.569, −0817)); meanwhile, in various diagnosis subgroup, EE can less hospital stay (BETA − 2.365; 95%CI (−3.498, −1.232) and BETA − 2.193; 95%CI (−3.569, −0817)) (Fig. 2).
Fig. 2.
Subgroups analysis of the hospital stay. Three subgroups was analysis to testify the relationship between the early extubation and hospital stay. GPOB, Gastrointestinal perforation, organ rupture and bleeding; GO, Gastrointestinal obstruction.
Discussions
The timing of extubation varies widely between clinicians and institutions. In recent years, ventilator weaning protocols have been introduced to facilitate safe and timely extubation14,15. Prolonged intubation may increase the use of sedatives, the risk of infection and iatrogenic injury; conversely, early termination may lead to reintubation, which may increase mortality and morbidity16,17. Postoperative extubation criteria are not established for patients undergoing AHA. It is currently unknown whether EE practices affect outcomes in these patients. Thus, in this retrospective cohort study, “extubation criteria” were developed specifically for AHA surgery, and impact of EE on postoperative outcomes was evaluated.
As China has been experiencing the COVID-19 pandemic since 2020, we harvested AHA surgery patients from 2012 to 2019. In our hospital, we did not observe any noticeable change in the composition of anesthesiologist-surgeon teams since 2012. The clinical experience of these teams should have increased over time; however, surprisingly, EE did not increase over time with their increasing experience. It indicates that EE might depend upon more factors than simply clinical experience alone. Increasing ICU beds made patient transfers easier; the economic conditions of individual patients or national healthcare policies might also play a role. Additionally, factors such as the patient’s medical condition and hemodynamics also influence EE decisions18. In our study, EE patients typically had a higher BMI, lower ASA classification, and underwent laparoscopic surgery more often. Therefore, this research highlights the significance of developing a standard criterion to provide EE after surgery. In a large study of ventilated patients in a surgical ICU, an extubation protocol that reduced extubation time demonstrated a reduction in ventilator-associated pneumonia, reintubation, and shorter length of stay after implementation19,20. For AHA surgery patients, we proposed a set of extubation criteria for the first time in this study. “Extubable status” are determined by integrating previous guidelines for intubation and extubation and evidence-based evidence about extubation in critically ill patients, as well as other factors such as clinical experience21. The criteria for extubation include parameters such as consciousness, oxygenation, and circulation.
Moreover, safe extubation requires a stable cardiovascular system. At present, there is insufficient evidence to confirm what dosage of vasopressors is suitable for safe extubation22. For our proposed “extubation criteria”, we suggest a minimum dose of vasopressors based on clinical experience. This is because the reduction in vascular tone caused by anaesthetics may require an additional dose of vasopressors. Of the 1,534 patients we studied who reached the “extubatable condition”, only 671 were successfully extubated within 4 h, with a low reintubation rate and no postoperative aspiration. It should be noted that the 4-hour cutoff was pragmatically chosen based on ICU workflow constraints. In our center (and many ICUs globally), post-surgical extubation decisions are often deferred until morning rounds due to staffing limitations. This creates a “clustered” extubation pattern rather than a continuum. In addition, re-intubation was rare, mainly due to changes in the patient’s condition after surgery. Compared with EE, DE did not reduce reintubation rates. These results suggest that the extubation criteria may contribute to safe extubation. The potential benefits of EE have been the subject of much interest in recent years, with many studies investigating its effects in different patient populations. Our study adds to this growing body of evidence by focusing on a unique cohort: AHA surgeries. The results are consistent with previous studies that demonstrated the advantages of EE in cardiac surgery23 and neurosurgery24. One possible explanation for the benefits of EE is its potential ability to reduce complications associated with long-term mechanical ventilation, including ventilator-associated pneumonia, barotrauma and ventilator- associated lung injury19. Additionally, EE can accelerate patient mobilization postoperatively and thus contribute to the reduction of postoperative complications like deep vein thrombosis and atelectasis25. Using non-parametric test analysis, we found that postoperative pulmonary infections were more common in DE than in EE patients. In our univariable regression analysis, we found that EE was positively associated with shorter hospital stay; intubation duration had no statistically significant association with total hospital stay. This may be attributable to substantial variations among patients regarding intubation duration, with these differences possibly being driven by factors like admission time and healthcare provider characteristics that impact how quickly an intubation takes effect, possibly masking any correlations between intubation duration and hospital stay duration. An intriguing correlation was identified between postoperative mortality and total length of hospital stay; likely as the result of patient deaths which lead directly to discharge - unfortunately we could not access their survival status after discharge from hospital.
This study was conducted with the aid of a large and comprehensive dataset sourced from a major hospital, which provided a wealth of detailed information. However, our research has several limitations. As an observational retrospective analysis, our findings may be influenced by unmeasured confounders including subtle hemodynamic variations, and undocumented clinical decision-making factors. Notably, our dataset lacked several critical parameters that could refine extubation timing decisions: non-invasive ventilation requirements following extubation, precise vasoactive medication titration records, Bispectral Index (BIS) monitoring data for anesthetic depth assessment, and dynamic stroke volume variation (SVV) measurements for fluid responsiveness evaluation. These limitations highlight the key areas for future research: multicenter prospective studies incorporating standardized extubation protocols and advanced monitoring (e.g., continuous BIS/SVV tracking) are needed to validate our findings. Such studies should particularly focus on high-risk subgroups identified in our analysis (laparotomy patients, vasopressor-dependent cases) while implementing long-term follow-up to assess functional recovery outcomes.
Conclusions
In conclusion, our findings suggest that EE is associated with shorter hospital stays and a lower risk of respiratory complications in AHA surgery patients. These findings support the incorporation of EE protocols into postoperative management strategies for this patient population. Further research is needed to confirm these findings and establish the optimal extubation strategy for this patient population.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
None.
Abbreviations
- AHA
acute high-risk abdominal
- ARDS
acute respiratory distress syndrome
- ASA
American Society of Anesthesiologists
- BIS
bispectral index
- BMI
body mass index
- COPD
chronic obstructive pulmonary disease
- EE
early extubation
- FiO2
fraction of inspired oxygen
- ICU
intensive care unit
- IQR
interquartile range
- SVV
stroke volume variation
- PaO2
arterial oxygen pressure
Author contributions
Conception and design: CD Analysis and interpretation: LG, CD Data collection and writing the article: LG, CD.
Funding
This work was supported by the Natural Science Foundation of Hunan Province Project 2022JJ40776 (to CD).
Data availability
The datasets generated and/or analysed during the current study are not publicly available due to legal restrictions and data security but are available from the corresponding author on reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
This study was approved by the Ethics Committee of Xiangya Third Hospital (approval number:23361) with a waiver of informed consent requirements.
.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and/or analysed during the current study are not publicly available due to legal restrictions and data security but are available from the corresponding author on reasonable request.